Most people don’t know they have raised cholesterol. There are no clear symptoms. For some, the first sign might be a heart attack.

Andrew Pyne from Cereal Partners having his cholesterol tested by Andrew Greaves of BHR Pharmaceuticals. Find out more about when to get your cholesterol tested, what is involved and what the results mean.

Saturated Fat and Heart Health

With lots of conflicting messages in the media about the relevance of diet in heart health, its no wonder than most of us are confused about what to eat less of and what to eat more of.

Newspaper headlines can be misleading. They often don't reflect all the available scientific evidence. And how often do we hear things from friends, family and doctors that might conflict with what we have been told already. Here we answer some of your commonly asked questions about fats and heart health.

Q

I’ve heard that saturated fat isn’t bad for my heart after all, so why can’t I eat butter rather than ‘low fat’ spreads?

A

Saturated fats (like those in butter) increase cholesterol

Backgound
It is clear that eating too much saturated fat increases the levels of cholesterol in the blood, especially our "bad" cholesterol which doctors refer to as LDL cholesterol. Saturated fats are found in a wide range of animal foods (fatty meats, butter, lard, full fat dairy) and in palm and coconut oils too. Eating less saturated fat, and very importantly replacing it with vegetable fats such as those found in nuts and seeds, helps lower the level of harmful cholesterol in the blood and reduce your overall risk of having a heart attack.

Q

I only eat foods low in fat so why wouldn't my diet be heart healthy?

A

A heart healthy diet is not a low fat diet. It is vital to swap saturated fat with heart healthy fats from nuts and seeds.

To maximise the cholesterol lowering effect of reducing saturated fat it is vital to replace saturated fat with unsaturated fats. These are best found in oils and spreads made from olives, nuts and seeds, from the nuts and seeds themselves and from foods such as avocado and oily fish. About a third of our energy should be provided by fat (that’s about 70g for a woman and 90g for a man each day) and of this no more than a third should be the saturated kind.

Q

Yes my cholesterol level is high, but I don’t have any other risk factors so surely that doesn’t matter?

A

A raised level of cholesterol is an independent risk factor regardless of the other risk factor you have.

Experts now know that having high levels of cholesterol over many years can result in early cardiovascular disease regardless of whether you have other risk factors. In fact the World Health Organisation attributed a third of deaths worldwide to raised cholesterol in 2010.

Many studies have shown that reducing cholesterol has a beneficial effect on health. For instance:

The Cholesterol Treatment Trialists Collaboration (CTTC), involving over 90,000 people, showed that major vascular events can be reduced by about one fifth for every mmol/L reduction in LDL (bad) cholesterol.

The INTERHEART case-control study estimated that 45% of heart attacks in Western Europe and 35% of heart attacks in Central and Eastern Europe are due to abnormal blood fats (also known as lipids). They estimated that individuals with abnormal lipids are at over three times the risk of a heart attack compared to those with normal lipids.

Q

It’s not saturated fat that’s to blame its trans fats and sugars that are the problem surely?

A

Trans fats are harmful but our intakes are under control. However we still eat too much saturated fat.

Trans fats are produced from the heating of unsaturated fats to high temperatures, often in industrial processing. Experts have been concerned about them for some time because they increase LDL (bad) cholesterol and also lower HDL (good) cholesterol. So this joint effect makes trans fats a big problem.

More recently the food industry has removed much of the trans fats from our diet. So most of us are eating fewer trans fats and it's less of a concern.

There is very little evidence that sugars actually raise cholesterol. Any increase in cholesterol is likely to come from an increase in calorie intake above our energy needs rather than from the sugars themselves. However sugary foods bring little to the diet in terms of nutrients, don't fill us up, may increase weight gain and also increase the likelihood of developing diabetes so they are best kept to a minimum.

Q

I’m not losing weight with the diet advice my doctor/dietitian/practice nurse gave me so what’s the point of carrying on?

A

Fat stored around the waistline (intra-abdominal fat) is more harmful than fat stored around the hips, so focus on waist reduction.

In terms of cholesterol, it is not so much about the amount of fat we have but where on the body we store it. People who are "apple shaped" are more likely to store fat in and around their liver, heart and pancreas. This is associated with the metabolic syndrome and unhealthy patterns of cholesterol. If you are apple shaped any changes you make to your diet and activity levels should focus on waist reduction not weight reduction. Routinely measuring your waist circumference is a good way to show the progress you are making.

Q

I’m young and at a healthy weight so surely I can’t have high cholesterol?

A

People who are young, slim or otherwise healthy can have high cholesterol without knowing it.

Cholesterol is partly genetically determined, so it’s just not possible to second guess a person’s cholesterol level without a blood test. Family history of high cholesterol or early heart disease, being apple shaped, an unhealthy diet and lifestyle are all indicators that cholesterol might be high.

Q

I’m on a statin so why do I need to worry about eating healthily?

A

Even if you are on a statin eating a healthy diet can have additional benefits.

Whether you are on a statin or not, eating a healthy diet is still an important part of maintaining healthy cholesterol levels. The cholesterol lowering effects of a healthy diet and a statin are additive. Cholesterol aside, eating a healthy diet can help improve and keep you in general good health.

Q

Should I start to use coconut oil as I’ve heard it’s good for heart health?

A

Coconut oil is almost entirely saturated fat and raises LDL-cholesterol, your "bad cholesterol". It is best avoided.

Coconut oil is solid at room temperature so there should be no surprise that it is really high in saturated fat. It contains two main saturated fats called lauric and myristic acids. Both these fats increase your LDL or "bad" cholesterol. Some have suggested that because lauric acid also raises the levels "good" cholesterol it might have health benefits. However the small increase in good ((HDL) cholesterol is far outweighed by the negative increase in bad (LDL) cholesterol.